Q&A coding 11772 or 14001

[Marge Atkinson]

I have a physician who "was told by another physician" that if he performs a pilonidal cyst excision that requires a flap closure, he should be coding 14001 not 11772. His rationale was that 14001 has a higher RVU. I tried to explain to him that CPT 11772 is a complicated pilonidal cyst excision to include flap closure. He is insistent that he did more than a W, Y-V plasty and wants proof that it would be incorrect coding to use 14001. I explained to him that the correct way to code this case would be 11772-22 and he would need to document why this was more difficult (complexity) or why it took significant more time to support his request to be reimbursed above his standard contract rate for CPT 11772. I am in need of support documentation (if any exists) to provide to him explaining why CPT 11772 is the correct CPT code to use. I have been able to find very limited articles referencing this situation. If the physician did a rotational flap closure, is that included in CPT 11772? (to me it is... ) Your advice/comments are greatly appreciated!

Regards,
Margaret Atkinson, BS CPC RMC

 

[Alicia Scott]

Margaret I am going to send your question to a couple of my coding friends. I respect their opinion. Not sure of the time frame they will get back with me but it is usually in a day or two. I don't have an answer for you and I think they may have encountered this before.

 

[Alicia Scott]

From my friend Vanessa:
The Lay Description for 11772 should be sufficient and ultimately they are responsible for coding, billing and documentation for reimbursement. I think you did a great job describing and explaining the differences between the 2 codes.

A pilonidal cyst or sinus is entrapped epithelial tissue located in the sacrococcygeal region above the buttocks. These lesions are usually associated with ingrown hair. A sinus cavity is present and may have a fluid-producing cystic lining. With a small or simple sinus in 11770, thephysician uses a scalpel to completely excise the involved tissue. The wound is sutured in a single layer. In 11771, an extensive sinus is present superficial to the fascia overlying thesacrum but with subcutaneous extensions. The physician uses a scalpel to completely excise the cystic tissue. The wound may be sutured in several layers. In 11772, the sinus involves manysubcutaneous extensions superficial to the fascia overlying the sacrum. The physician uses a scalpel to completely excise the cystic tissue. Local soft tissue flaps (i.e., Z-plasty, Y-V plasty, myofasciocutaneous flap) may be required for closure of a large defect or the wound may be left open to heal by granulation.

 

[Marge Atkinson]

thank you Alicia. Often I have a difficult physician who wants to see written proof that he is incorrect. I already gave him numerous coding articles describing CPT 11772 and the types of closures it includes but he maintains that none mention a rotational flap closure. Anything you can find is greatly appreciated.